Should NPs replace School Nurses?

[AAC.271]

As an sNP i've been worried about the constant concerns expressed by my peers about the overabundance of NP graduates. With changing times i think I have an excellent measure to raise the quality of care and to possibly generate some revenue or at least break even for schools (elementary, high school, middle schools).

Currently, every school in the US has a nurse that serves as the primary healthcare provider for all the students at a school responsible for temporarily managing everything from broken bones to sudden onset seizures to the flu. With the oversupply of NP's and the requirement that all NP's must be RN's first, do you folks think it is a good idea to allow independent practice nurses to start operating a pediatric clinic at schools? They will serve as your typical school nurse, but a greater scope of practice and no longer a need to always refer to the local pediatrician or family doctor. This will truly exemplify the front lines of medicine and can serve as a way to increase the quality of healthcare for our kids when they are at school. Economically, as they do it at many universities, there could be a system set up whereby either the government helps cover the cost or the NPs can bill accordingly so the costs for a school would be minimal.

Innovative and Progressive? Definitely! Welcome to the 21st century!! Your Thoughts?

[sailornurse]

School-based health centers already exist. Most are staffed by nurse practitioners in my town and in other cities. And no not every school has a nurse , some have an assistant sometimes the nurse has to cover two or three schools. Consider also that some schools such as high schools have a population of 2500 students may be more in bigger cities.and then there is your mention of the government paying for this. That would require possible grants which is known as soft money when the Grant runs out the money runs out. And someone to write the grant. Not sure it would be cost-effective to have an NP full-time as a school nurse either. Do you know the salary for school nurses?

[guest769224]

First you tell us NP's should replace doctors, now school nurses, what's next?

[RatherBHiking, BSN, RN]

Sailornurse is right. We have two school health based centers in our district already staffed by a NP each place, a dr between the two, and secretary at each. We don't have enough room, money, or need for one at every single school (we have around 30 schools in the district.) The two schools I mentioned have both a school nurse and a NP. They have completely separate duties, offices, and both are constantly busy. There's no way one would be able to do it all. Also correct is that yes every school may have a nurse assigned to them but not every day. Some schools see a nurse once a week. We have several school with only 200-300 kids. That's too small to be cost effective. Plus the pay is much lower in a school system for nurses. Not a huge incentive to get a higher degree.

I see between 30-40 kids a day and I only refer to a dr/np maybe 2-3 a week. We can provide transportation to one of our health based centers if needed but with 2 urgent cares closer many just opt to go there. I understand what you're saying but it's already been researched and done the best way that will work for school districts.

[JenTheSchoolRN, BSN, RN]

I see between 30-40 kids a day and I only refer to a dr/np maybe 2-3 a week. We can provide transportation to one of our health based centers if needed but with 2 urgent cares closer many just opt to go there. I understand what you're saying but it's already been researched and done the best way that will work for school districts.

THIS. As a school nurse, I can tell you most of what I see in my office does not need to be handled by a NP. I see anywhere from 30-60 kids a day,a good chunk need a check-in/reassurance/water/feminine supplies/scheduled med.

I think every school should have a school nurse to assess (which we don't have), but not every school needs a NP. Nurses are used as triage in many areas of health care, including schools. It works well. Not to mention the cost. School nurses are generally not paid well, usually much less than many other areas of nursing. I don't think my district could afford to pay a NP full-time.

[HouTx, BSN, MSN, EdD]

Actually, OPs post is misleading. I'm not sure what mandate OP is referring to, but there is certainly not a nurse in very school in my part of the country. In this area, many financially strapped districts are using LVNs - supervised by a single beleaguered RN responsible for covering multiple schools. Unthinkable, right?? Particularly in instances where medically fragile children are being mainstreamed... not to mention all of the pharmaceutically dependent kiddos, what with the apparent epidemic of ADHD & elementary kids on anti-anxiety meds.

I really doubt whether parents are fully informed about this situation. They probably have no idea that teachers are being asked to administer meds & under go training (hopefully) to respond to medical emergencies.

So - I really love the idea of school-based NPs, but don't think it's realistic unless they are willing to donate their time. School districts don't have the money & lack the incentive to prioritize student health as they should. This would be a wonderful public health platform for nursing to lead.